JUDY WOODRUFF: So how do the presidential candidates say they can fix the health care problems in New Mexico and throughout the nation? For that, we turn to health care experts representing both campaigns.

Here on behalf of Barack Obama is Michelle Lujan Grisham. She’s former health secretary of New Mexico. And Dr. J.R. Damron, he is John McCain’s state health care chair and a practicing radiologist in Santa Fe.

Thank you both for being here.

And let’s start — we heard a pretty grim picture or saw a pretty grim picture painted there of the health care situation in this state. But let me begin with you, Dr. Damron. What about this real problem of access, people who not only don’t have insurance coverage, don’t have a way to get to a doctor or a nurse?

DR. J.R. DAMRON, McCain campaign: Access is a huge problem. It’s not just in New Mexico; it’s a problem throughout the United States. I mean, we are in a real critical shortage for health care providers, whether they’re nurses or whether they’re physicians or nurse practitioners…

JUDY WOODRUFF: And what would Senator McCain do about that, if president?

DR. J.R. DAMRON: Well, Senator McCain understands this. He understands that there is a health care shortage. He would put federal monies into this. He would try to help in whatever way possible to support the states, as well as a nation — we have enough health care providers for our population.

JUDY WOODRUFF: And, Michelle Grisham, what would Senator Obama do?

MICHELLE LUJAN GRISHAM, Obama campaign: Fundamental differences. Senator Obama is going to invest in providers directly, which means we’re going to do loan forgiveness, we’re going to have incentives for practicing in rural areas, we’re going to invest in prevention and public health models.

We’re going to have health information technology, which connect you to physicians and specialists. And you do this by recognizing that we’re going to have a better model for guaranteeing access to insurance coverage for New Mexicans and all Americans.

JUDY WOODRUFF: Cost? How do you pay for it?

MICHELLE LUJAN GRISHAM: Oh, cost. Two things. We can save $50 billion to $65 billion by taking waste out of the current system. Twenty-five percent of all the money that you spend in premiums and direct care goes to overhead and administrative burdens.

And the second way we do that is tax reform, so that folks paying — making the most money and paying the fewest taxes would now pay their fair share.

Government's role in health care

JUDY WOODRUFF: And why isn't that approach the right approach, Dr. Damron?

DR. J.R. DAMRON: Regulation. If you want more federal regulation, if you want more government mandates and regulation and subsidies, then the Obama plan would be the way to go.

But the McCain plan is based upon access, affordability of costs, as well as choice, and an increase in the competition in the private market. So, I mean, there is a significant difference here.

And there's no other issue that is before these two candidates that separates the differences. I mean, we agree on certain things. And there's bipartisan agreement on certain things, like prevention, wellness, chronic disease management, even probably the pharmaceutical industry.

JUDY WOODRUFF: But the crux of the difference you're saying is the role of government here? Is that what you're saying?

DR. J.R. DAMRON: I think it's the role of government. If you go down the left side, you're going to go with the Obama plan. And if you go down the right side, you're going to go with the McCain plan, which is more free enterprise versus government -- heavy government regulation.

JUDY WOODRUFF: Is that the crux of it?

MICHELLE LUJAN GRISHAM: Oh, it's the crux, but it's, I think, an inaccurate statement about who gets what. Under the Obama plan, for the first time we're protected. We have guaranteed access to insurance.

I can't get insurance. I'm the kind of person that would be excluded because of a pre-existing condition. There's more burden on the patient in the McCain plan.

You shop when you're sick. You shop when you're a caregiver. That makes no sense at all.

When we talk about regulation, we're talking not about regulation. We're talking about protecting individuals. Talk to senior citizens about having a prescription drug plan with their particular drug on it only to find out within seven days later that that drug can be unilaterally taken off the market.

They don't have access. It's about protections.

Employer or individual insurance

JUDY WOODRUFF: Dr. Damron, John McCain does move away from the current employer-based insurance model. Why does he think that the current system isn't working?

DR. J.R. DAMRON: Well, it has worked for us in the past, and it worked very well. But there are costs -- the cost of medical care far out-surpass the cost for inflation.

So what he feels like should happen is that, because less and less employers are providing health care for their employees, that we should move away from an employer-based model in which the employer gets the tax benefits to a model in which the individual or the family gets the tax benefit.

JUDY WOODRUFF: And why doesn't that work?

MICHELLE LUJAN GRISHAM: Bait-and-switch. You know, you get a tax credit and then it's not enough to pay for your premium. And employers are actually incentivized to drop coverage for their employees.

What we heard on the tape or you saw in southern New Mexico was an employer who wants to provide health insurance for his employees but he can't afford to provide it.

This is a plan that invests in those small providers, by giving them a tax credit and assistance with health care coverage for their employees. That's exactly how you build access in this plan.

JUDY WOODRUFF: And what would Senator McCain do about those small employers?

DR. J.R. DAMRON: Well, the small employers -- look at it like this. Right now, they're already paying for health care benefits for their employees. We're giving the tax benefit to the individual or to the family, $2,500 per individual, $5,000 for the family.

So in addition, that employer will not be buying health care coverage. And a lot of employees, including my own employees, do not want to have the type of health care that I choose as an employer for them. So they will -- I will do -- with that extra money, I'll put that back into salaries for them.

Let's not forget that, for the first time ever, McCain is proposing to actually tax your health care benefits. I mean, it is really classic bait-and-switch, which is I promise to give you something, but in the end I'm going to tax you somewhere else in order to pay for my plan.

JUDY WOODRUFF: What about that point?

DR. J.R. DAMRON: Well, I'm going to have to disrespectfully disagree with that, because it's -- of course, you know, any time that you get money, there's going to be a tax, but the amount of tax is significantly lower than what you're getting back as a refundable tax credit from the government.

And in addition, you get the choice of what type of plan that you might want to have for yourself or for your family, which we don't have with the employer-based health care plan currently.

MICHELLE LUJAN GRISHAM: You absolutely do. Obama is saying, if you're happy with what you have now, you get to keep it. If you can't get access, I'm going to make sure that you do that.

And here's the real difference. I'm going to invest in you, people first, make sure that you have coverage. And the McCain plan is putting patients and individuals out on their own.

Disagreement over plans

JUDY WOODRUFF: And just quickly, the criticism that Senator Obama's approach would lead to government takeover of health care in this country?

MICHELLE LUJAN GRISHAM: Absolutely not. This is reinvesting and supporting small business privately, insurance markets. That's what we're investing in. And then we're going to shore up government programs.

This is about protection. When they talk about regulation, it's an absolute misnomer. It's about protecting patients and families to have access.

JUDY WOODRUFF: You're shaking your head.

DR. J.R. DAMRON: I have to disagree with this. You know, the Obama plan relies heavily on the government mandates and on regulations, on subsidies.

He wants to put in a national health care exchange plan as a new plan for the federal government, which will then compete against our private insurance industry.

With this new plan, which is sort of based like Medicare, but it could be toward Medicaid, what we've got then is a lead-in toward -- and people are concerned about this -- toward single-payer system, which would be a totally government-run program.

MICHELLE LUJAN GRISHAM: This attack on the Obama plan is really, in my mind, because -- utilized, because McCain does not have a comprehensive federal health care plan or policy that achieves these things: affordability, access, accountability, quality, and choice for New Mexicans and Americans.

And until we do that, no one has guaranteed, protected access to health care.

JUDY WOODRUFF: Fundamentally different approaches from the two candidates. And we thank you both for being with us, Michelle Lujan Grisham and Dr. J.R. Damron.

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